How Reliable Is Laparoscopic Colorectal Surgery Compared to Open Surgery for Octogenarians?

Background: Considering today’s increased longevity in the elderly population, and the increased size of that population major abdominal intervention is more frequently performed in octogenarians.
Objective: To compare the surgical and postoperative outcomes of laparoscopic colorectal resections to open surgery in the octogenarian population.
Methods: A retrospective analysis based on a prospectively maintained database of octogenarians who underwent laparoscopic or open elective colorectal resections from 2001 to 2008 was performed. Diagnosis, comorbidities, operative data and early postoperative complications were analyzed in this report.
Results: One hundred ninety-nine octogenarians underwent colon resection. Laparotomy was performed in 116 patients (group I) and laparoscopic surgery in 83 (group II). The mean age was 84.3 vs. 84.7 and the mean ASA score was 2.8 vs. 2.6 in groups I and II, respectively. Colorectal adenoma was the most common indication for surgery in both groups (77.6% vs. 54.2% in groups I and II, respectively) And right-hemi colectomy was the most frequently performed operation in group II (31% vs. 57.8% in groups I and II, respectively; p=0.0003). Open resections had a higher mean blood loss (286ml vs. 152ml, in groups I and II respectively; p=0.0002), and more patients required intraoperative transfusions (p=0.005), despite similar operative times. The conversion rate in the laparoscopic group was 25.3%. The laparoscopic patients had less overall complications, and clinical morbidity (p<0.05). The median length of stay was 8 days in group I compared to 6 days in group II (p=0.0065). The rate of major surgical complications was similar for both groups of patients (6% vs. 4.8%, in groups I and II respectively). The reoperation rates were 2.6% and 3.6% (p>0.05) and mortality rates were 3.4% vs. 2.4% in groups I and II respectively.
Conclusions: Laparoscopic colorectal resection is effective and safe for octogenarians with less blood loss and faster postoperative recovery associated with lower morbidity when compared to laparotomy.

Session: Podium Presentation

Program Number: S101